By Carolyn Crist

(Reuters Health) – When middle-aged women realize their cervical cancer risk from HPV lasts decades, more of them decide to get screened for this cancer than when they only know HPV has a role in cancer, without an explicit timeline, a small study found.

Human papillomavirus can cause cervical cancer up to 30 years after infection. Older women may think their sexual activity levels today don’t put them at risk – so uncoupling their risk perception from their current sex lives could encourage middle-aged women to understand they still need cervical cancer screening, the study authors write in the journal Sexually Transmitted Infections.

“Women in their 50s and 60s who are putting off screening because they do not think they are at risk anymore should know that it is still important for them to be screened,” said Laura Marlow of University College London in the UK, who led the study.

Since the most common risk factor typically mentioned in relation to cervical cancer is having multiple sexual partners, women in this age group may not think they have a risk for human papillomavirus (HPV) or cervical cancer, and they’re also more likely to make an active decision not to be screened, Marlow said.

“Women can benefit from regular cervical screening, not only protecting them against cervical cancer during this period, but also into their 70s and 80s,” Marlow told Reuters Health by email. “This cohort has not been offered HPV vaccination, so attending screening is their only opportunity to prevent cervical cancer.”

Marlow and colleagues studied nearly 600 women in the UK aged 50-64 who said in an initial survey that they did not intend to get cervix screening. Researchers randomly assigned the women to three groups, each of which was given a text with information about HPV to read.

Women in one group received what the researchers called “cause only” information about HPV and cervical cancer, a second group received “cause with basic timeline” information explaining that HPV can cause cervical cancer long after infection (10-30 years). The third group received “cause with explicit timeline” information, which included the information given to the second group plus the explicit statement, “This means that even if you have not been sexually active for a long time or have only had one partner for a long time, you could still be at risk of cervical cancer.”

Most women were overdue for a screening, and about one in six said they had never been screened.

When surveyed again, women given the explicit timeline text were more likely to see themselves as at higher risk than they had realized, and planned to attend a screening. About 24% said their perception of their risk of cervical issues increased, compared with 9% of those in the “cause only” group. Similarly, 25% increased their intention to attend a screening, as compared with 13% in the “cause only” group.

In addition, among women with four to 10 sexual partners or more during their lifetime, perceived risk more than doubled compared to women with one or no lifetime partners, and intention to get screened more than tripled.

“There’s a perception that this is a young woman’s disease, but the data demonstrate it’s not, particularly with later-stage cancers that are harder to treat,” said Sue Sherman of Keele University in Staffordshire, UK, who wasn’t involved in the study.

“It’s important for women to know that even if they’re not having sex, it doesn’t mean they aren’t at risk anymore,” Sherman said in a phone interview. “We need to change our messaging around HPV and screening.”

Future studies should look at the gap between screening intention and the actions that follow, Sherman noted.

“Women who have not had a new sexual partner for 35 years could still have a silent HPV infection picked up in their 20s, which could become cancer in the future, so screening is worthwhile,” said Peter Sasieni of King’s College London, who also wasn’t involved in the study.

“We are all influenced by seemingly minor changes in the wording of letters we receive,” he said by email. “Well-informed women are more inclined to have cervical screening than less well-informed women.”

SOURCE: Sexually Transmitted Infections, online August 8, 2019.